What is needed for informed decisions about prostate cancer screening: perspectives of African-American and Hispanic men

Damaged Masculinity: How Honor Endorsement Can Influence Prostate Cancer Screening Decision-Making and Prostate Cancer Mortality Rates

Prior research has established factors that contribute to the likelihood that men seek out prostate cancer screenings. The current study addresses how endorsing the ideology found in cultures of honor may serve as a barrier to prostate cancer screenings. Two studies were conducted which analyzed the impact of stigma on men's decisions to seek out prostate cancer screenings (Study 1) as well as how prostate cancer deaths may be higher in the culture of honor regions due to men's reticence to seek out screenings (Study 2). Results suggest that older, honor-endorsing men are less likely to have ever sought out a prostate cancer screening due to screening stigma and that an honor-oriented region (southern and western United States) displays higher rates of prostate cancer death than a non-honor-oriented region (northern United States). These findings suggest that honor may be a cultural framework to consider when practitioners address patients' screening-related concerns.

A large-scale, geographical approach to using group concept mapping for planning: The Teen Opinions Count (TOC) project

The use of group concept mapping (GCM) for large-scale, multi-site planning has been limited. The Teens Opinions Count (TOC) project utilized the group concept mapping methodology to develop a framework for after school time program development for teens in 16 counties in the Southeast Michigan and Western New York regions. This extensive planning effort demonstrated a large-scale, geographical approach to the implementation of GCM, where multiple sites (in this case counties) simultaneously engaged in independent processes on the same topic, with the purpose of producing separate locale-specific conceptualizations. TOC was the largest GCM project ever conducted in terms of the number of participants and volume of data submitted. This report details GCM recruitment, data collection, data compilation, and analysis of ideas from over 20,000 teens and 2,000 adults. Although implementation was conducted at the county level, many of the separate county-level GCM processes were larger than what is typically encountered in the literature. Operationalizing GCM at such a scale required significant planning, design, communication, and data management solutions. The extensive data collection effort required the need for creative and innovative procedures to engage teens and process the sheer volume of data. The lessons learned are discussed and suggestions for future applications offered.

Decision-making support among racial and ethnic minorities diagnosed with breast or prostate cancer: A systematic review of the literature

OBJECTIVE

To describe the types of decision-making support interventions offered to racial and ethnic minority adults diagnosed with breast or prostate cancer and to draw any associations between these interventions and patient-reported quality of life (QoL) outcomes.

METHODS

We conducted literature searches in five bibliographic databases. Studies were screened through independent review and assessed for quality. Results were analyzed using inductive qualitative methods to determine thematic commonalities and synthesized in narrative form.

RESULTS

Searches across five databases yielded 2496 records, which were screened by title/abstract and full-text to identify 10 studies meeting inclusion criteria. The use of decision aids (DAs), trained personnel, delivery models and frameworks, and educational materials were notable decision-making support interventions. Analysis revealed six thematic areas: 1) Personalized reports; 2) Effective communication; 3) Involvement in decision-making; 4) Health literacy; 5) Social support; and 6) Feasibility in clinical setting.

CONCLUSION

Evidence suggests decision-making support interventions are associated with positive outcomes of racial and ethnic minorities with patient-reported factors like improved patient engagement, less decisional regret, higher satisfaction, improved communication, awareness of health literacy and cultural competence.

PRACTICE IMPLICATIONS

Future decision-making interventions for racial and ethnic minority cancer patients should focus on social determinants of health, social support systems, and clinical outcomes like QoL and survival.

A Survey of the Knowledge of African-American Women About Prostate Cancer Screening

Prostate cancer is the second most common cancer diagnosed in men. Its incident and mortality rates are generally higher in populations of African descent. The scientific community recommends that men should be informed of the benefits, risks, and limitations of screening in order to make an informed decision regarding participation in prostate cancer screening. Women are known to act as the healthcare gatekeeper for the family. As such, African-American (AA) women could facilitate the informed decision-making process by providing prostate cancer and screening information to AA men. However, little is known about AA women's knowledge regarding prostate cancer and screening. This report describes the findings of a non-experimental cross-sectional study conducted using a convenience sample of 200 AA women. Data was collected using the knowledge subscale of the Eastland prostate cancer survey. Data was analyzed using JMP 13 statistical software developed by Statistical Analysis Systems (SAS) Institute. The overall mean knowledge score was 6.59 (47.1%). Knowledge was significantly associated with personal or family history of cancer (p = .02), family history of prostate cancer (p = .002), and the age of the respondents (p = .004) with those of older age (51 years and above) scoring higher on the knowledge scale. The results indicated that the AA women had a low knowledge of prostate cancer and screening. The findings indicate the need to develop and implement prostate cancer educational programs that include AA women.

Factors influencing black men and their partners' knowledge of prostate cancer screening: a literature review

Prostate cancer is the most commonly diagnosed cancer in men in the UK, with 46 690 new cases in 2014. While there is sufficient research on this topic in the USA, there is no review in the UK regarding both black men and their significant others' perspective on prostate cancer screening.

AIM

To identify and explore factors that may influence black men and their significant others' knowledge and awareness of prostate cancer screening.

METHOD

A literature search revealed seven relevant articles.

RESULTS

Six of the seven articles were conducted in the USA. The results are described using four themes: perception of prostate cancer screening, fear, anxiety and discomfort, misinformation about prostate cancer screening procedures and communication and decision-making.

CONCLUSION

The evidence suggests that some black men and their significant others had knowledge and awareness of prostate cancer screening. However, their views were influenced by misperceptions, misinformation, fear and anxiety around screening procedures and mortality. Communication and spousal support were important in decision making.

Impact of visual impairment on the lives of young adults in the Netherlands: a concept-mapping approach

PURPOSE

While the impact of visual impairments on specific aspects of young adults' lives is well recognised, a systematic understanding of its impact on all life aspects is lacking. This study aims to provide an overview of life aspects affected by visual impairment in young adults (aged 18-25 years) using a concept-mapping approach.

METHOD

Visually impaired young adults (n = 22) and rehabilitation professionals (n = 16) participated in online concept-mapping workshops (brainstorm procedure), to explore how having a visual impairment influences the lives of young adults. Statements were categorised based on similarity and importance. Using multidimensional scaling, concept maps were produced and interpreted.

RESULTS

A total of 59 and 260 statements were generated by young adults and professionals, respectively, resulting in 99 individual statements after checking and deduplication. The combined concept map revealed 11 clusters: work, study, information and regulations, social skills, living independently, computer, social relationships, sport and activities, mobility, leisure time, and hobby.

CONCLUSIONS

The concept maps provided useful insight into activities influenced by visual impairments in young adults, which can be used by rehabilitation centres to improve their services. This might help in goal setting, rehabilitation referral and successful transition to adult life, ultimately increasing participation and quality of life. Implications for rehabilitation Having a visual impairment affects various life-aspects related to participation, including activities related to work, study, social skills and relationships, activities of daily living, leisure time and mobility. Concept-mapping helped to identify the life aspects affected by low vision, and quantify these aspects in terms of importance according to young adults and low vision rehabilitation professionals. Low vision rehabilitation centres should focus on all life aspects found in this study when identifying the needs of young adults, as this might aid goal setting and rehabilitation referral, ultimately leading to more successful transitions, better participation and quality of life.

A comparison of a centralized versus de-centralized recruitment schema in two community-based participatory research studies for cancer prevention

Use of community-based participatory research (CBPR) approaches is increasing with the goal of making more meaningful and impactful advances in eliminating cancer-related health disparities. While many reports have espoused its advantages, few investigations have focused on comparing CBPR-oriented recruitment and retention. Consequently, the purpose of this analysis was to report and compare two different CBPR approaches in two cancer prevention studies. We utilized frequencies and Chi-squared tests to compare and contrast subject recruitment and retention for two studies that incorporated a randomized, controlled intervention design of a dietary and physical activity intervention among African Americans (AA). One study utilized a de-centralized approach to recruitment in which primary responsibility for recruitment was assigned to the general AA community of various church partners whereas the other incorporated a centralized approach to recruitment in which a single lay community individual was hired as research personnel to lead recruitment and intervention delivery. Both studies performed equally well for both recruitment and retention (75 and 88 % recruitment rates and 71 and 66 % retention rates) far exceeding those rates traditionally cited for cancer clinical trials (~5 %). The de-centralized approach to retention appeared to result in statistically greater retention for the control participants compared to the centralized approach (77 vs. 51 %, p < 0.01). Consequently, both CBPR approaches appeared to greatly enhance recruitment and retention rates of AA populations. We further note lessons learned and challenges to consider for future research opportunities.

Treatment decisions for localized prostate cancer: a concept mapping approach

OBJECTIVE

Few decision aids emphasize active surveillance (AS) for localized prostate cancer. Concept mapping was used to produce a conceptual framework incorporating AS and treatment.

METHODS

Fifty-four statements about what men need to make a decision for localized prostate cancer were derived from focus groups with African American, Latino and white men previously screened for prostate cancer and partners (n = 80). In the second phase, 89 participants sorted and rated the importance of statements.

RESULTS

An eight cluster map was produced for the overall sample. Clusters were labelled Doctor-patient exchange, Big picture comparisons, Weighing the options, Seeking and using information, Spirituality and inner strength, Related to active treatment, Side-effects and Family concerns. A major division was between medical and home-based clusters. Ethnic groups and genders had similar sorting, but some variation in importance. Latinos rated Big picture comparisons as less important. African Americans saw Spirituality and inner strength most important, followed by Latinos, then whites. Ethnic- and gender-specific concept maps were not analysed because of high similarity in their sorting patterns.

CONCLUSIONS

We identified a conceptual framework for management of early-stage prostate cancer that included coverage of AS. Eliciting the conceptual framework is an important step in constructing decision aids which will address gaps related to AS.

The use of concept mapping to identify community-driven intervention strategies for physical and mental health

Research that partners with youth and community stakeholders increases contextual relevance and community buy-in and therefore maximizes the chance for intervention success. Concept mapping is a mixed-method participatory research process that accesses the input of the community in a collaborative manner. After a school-wide health needs assessment at a low-income, minority/immigrant K-8 school identified bullying and obesity as the most important health issues, concept mapping was used to identify and prioritize specific strategies to address these two areas. Stakeholders including 160 K-8 students, 33 college students working in the school, 35 parents, 20 academic partners, and 22 teachers/staff brainstormed strategies to reduce and prevent obesity and bullying. A smaller group of stakeholders worked individually to complete an unstructured sorting of these strategies into groups of similar ideas, once for obesity and again for bullying. Multidimensional scaling and cluster analysis was applied to the sorting data to produce a series of maps that illustrated the stakeholders' conceptual thinking about obesity and bullying prevention strategies. The maps for both obesity and bullying organized specific strategies into themes that included education, parental role, teacher/school supervision, youth role, expert/professional role, and school structure/support.

It takes two to talk about prostate cancer: a qualitative assessment of African American men's and women's cancer communication practices and recommendations

Prostate cancer (PrCA) is the most commonly diagnosed nonskin cancer among men. African American (AA) men in South Carolina have a PrCA death rate 150% higher than that of European American (EA) men. This in-depth qualitative research explored AA men's and women's current practices, barriers, and recommended strategies for PrCA communication. A purposive sample of 43 AA men and 38 AA spouses/female relatives participated in focus groups (11 male groups; 11 female groups). A 19-item discussion guide was developed. Coding and analyses were driven by the data; recurrent themes within and across groups were examined. Findings revealed AA men and women agreed on key barriers to discussing PrCA; however, they had differing perspectives on which of these were most important. Findings indicate that including AA women in PrCA research and education is needed to address barriers preventing AA men from effectively communicating about PrCA risk and screening with family and health care providers.

A community-based intervention to promote informed decision making for prostate cancer screening among Hispanic American men changed knowledge and role preferences: a cluster RCT

OBJECTIVE

We assessed the short-term effects of a community-based intervention for Hispanic men to encourage informed decision making (IDM) about prostate cancer screening with prostate specific antigen (PSA).

METHODS

All senior social and housing centers in El Paso, TX were randomized to intervention, a group-based Spanish language educational program facilitated by promotores (12 centers; 161 men) [I's], or to control, promotores-facilitated diabetes video and discussion (13 centers; 160 men) [C's].

RESULTS

Participants had low levels of schooling and baseline knowledge; 44% reported previous PSA testing. At post-test, the I's made large knowledge gains, increased their understanding that experts disagree about testing, shifted toward more active decision making roles, were more likely to believe that it is important to weigh the advantages and disadvantages of screening and to anticipate potential screening outcomes in making a decision, and were less likely to consider the screening decision easy. The I's did not change in their screening intention or the belief that choosing not to be screened could be a responsible choice.

CONCLUSIONS

A community-based intervention to support IDM for prostate cancer screening can increase knowledge and may promote more active involvement in decision making about prostate cancer screening. Such an approach can increase knowledge and may promote more active involvement in decision making about prostate cancer screening.

PRACTICE IMPLICATIONS

It is feasible to develop and implement a community-based intervention program to promote IDM for prostate cancer screening.

Comparing knowledge of colorectal and prostate cancer among African American and Hispanic men

African American and Hispanic men are less likely to participate in prostate and colorectal cancer screening and have poorer outcomes from these diseases. Guided by the Patient/Provider/System Theoretical Model for Cancer Screening, this study compares the relationships among knowledge of prostate and colorectal cancer, perceptions of cancer fatalism, common sources of cancer information, and awareness of cancer resources screening between African American (n = 72) and Hispanic (n = 47) men who attend federally qualified health centers and a hospital-based primary care clinic in a southern state. African American men were older, had higher levels of education, and were more knowledgeable about cancer than Hispanic men were. However, Hispanic men were more fatalistic about cancer. Most men in both groups were more likely to get cancer information from the television and/or radio, with few accessing the Internet for this information. The men were not aware of many of the leading cancer-related organizations and programs. Nurses continue to play a critical role in patient education and enhancing screening rates. These findings suggest that culturally and educationally appropriate intervention strategies are needed to enhance knowledge and that the television/radio may be an effective medium for delivering these strategies.

Health decision-making preferences among African American men recruited from urban barbershops

OBJECTIVE

To examine general health decision-making roles among African American men ages 40 to 70 recruited in barbershops in the Richmond, Virginia, metropolitan area.

METHODS

We adapted the 1-item Control Preference scale to study the associations between health decision-making role preferences and demographic variables. Forty African-American men were recruited from barbershops to complete a self-administered survey. After performing descriptive statistics, we dichotomized our outcome into active vs nonactive (collaborative or passive) decision makers. Data were then analyzed using chi2, Wilcoxon-Mann-Whitney rank sum, and multiple logistic regression.

RESULTS

Fifteen subjects responded that they engaged in active decision making, 20 in collaborative, and 5 in passive decision making. Almost all (86.7%) active decision makers were home owners, vs 41.7% of nonactive decision makers. Among active decision makers, 46.7% had incomes of more than $70000, vs 12.5% of nonactive decision makers. The active group reported health status that was good to excellent, while 20.8% of those in the nonactive group reported poor/fair health.

CONCLUSION

African American male barbershop clients preferred an active or collaborative health decision-making role with their physician, rather than a passive role. The relationship among home ownership, income, and decision style may best be understood by considering the historical and cultural influences on gender role socialization among African American males. More comprehensive assessment of decision styles is necessary to better understand health decision making among African American male patients.